NY Manual
SHP Manual

New York Provider Manual
13.1 Overview | 14.2 Reporting Requirements and Quality Programs

14. Clinical Performance Management 

14.1 Overview and Philosophy

The Clinical Performance Management Program and Integrated Quality Plan is an organization-wide commitment that supports processes designed to improve the quality and safety of clinical care and the quality of service provided to our members. The Program utilizes clinical and service indicators to plan, implement, monitor, and improve the organization’s commitment to improve quality, maximize safe clinical practices, and enhance service delivery to our members. 

                      Key Objectives of the Healthfirst Clinical Performance Management:
1.    To establish and maintain a Clinical Performance Management Program and Integrated Quality Plan that demonstrates a commitment from the highest governing body of Healthfirst to every employee of the organization and to provide the highest possible quality in clinical care and service delivery to our members.
2.    To share with its participating providers clinical and service performance indicators by which care and member satisfaction are measured and to hold those accountable in the implementation of actions designed to improve performance.
3.    To establish a cyclical, continuous process of planning, assessing, monitoring, analyzing, measuring, and evaluating performance to improve desired outcomes.
4.    To demonstrate a quality process that ensures compliance with all rules and regulations set forth by local and federal regulatory agencies that affect all aspects of the organization’s business, service, and clinical operations.
5.    To implement and monitor educational materials and programs designed to empower members to take better care of themselves.        

Scope of the Integrated Quality Plan/CPM Program

The Integrated Quality Plan/CPM Program is applicable to all Healthfirst products. All aspects of the organization participate in every facet of the Plan’s overall quality improvement efforts. The overall goal of this program is to include both administrative and clinical initiatives that are monitored regularly and evaluated annually. All clinical performance activities, when applicable, shall be conducted in accordance with the National Committee for Quality Assurance (NCQA) Standards for the Accreditation of Managed Care Organizations and/or other reporting requirements as promulgated by the different regulatory agencies that oversee the organization, such as the New York State Department of Health (NYSDOH), New York City Department of Health and Mental Hygiene (NYC DOHMH), and the Centers for Medicare & Medicaid Services (CMS). Activities fall into two (2) major categories: activities that improve the quality and safety of clinical care, and activities that improve the quality of service provided to its membership.